Etiology and clinical spectrum of constipation in Indian children.

OBJECTIVE To analyze the etiology, clinical spectrum and outcome of constipation in children. SETTING Tertiary care teaching hospital. DESIGN Retrospective chart review. PARTICIPANTS Consecutive children with constipation from 2001 to 2006. INCLUSION CRITERIA Functional constipation was designated when there was no objective evidence of any causative pathologic condition while the rest were termed as organic constipation. INTERVENTION Lactulose was started after disimpaction with polyethyleneglycol in functional constipation cases. OUTCOME MEASURES Clinical and etiological profile, management, and follow-up data. RESULTS 137 children (boys, 90); 117 (85%), had functional constipation while the remaining 15% had an associated organic disorder. Hirschsprungs disease accounted for 6% of all patients. Children in organic group more commonly had delayed passage of meconium (50.0% vs 1.7%), symptoms since first month of life (40.0% vs 1.7%), and abdominal distension (50% vs 5%) as compared to functional group, while fecal impaction was less common (69% vs 20%). Besides fecal impaction, straining (35%), withholding behaviour (27.4%), and fecal incontinence (30.8%) were other main clinical characteristics of the functional group. In the functional group, successful outcome to laxatives was obtained in 95% of patients while 10% needed rescue disimpaction. CONCLUSIONS Functional constipation is the most common cause of constipation in Indian children. History of delayed passage of meconium, presence of abdominal distension, and absence of fecal impaction point to an organic pathology.